Provider Demographics
NPI:1518592922
Name:RIDLEY'S FAMILY MARKETS INC
Entity type:Organization
Organization Name:RIDLEY'S FAMILY MARKETS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-336-0310
Mailing Address - Street 1:5353 W 11000 N
Mailing Address - Street 2:ATTN TODD WISE
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-358-3365
Mailing Address - Fax:208-567-5622
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:SUITE 4D
Practice Address - City:COALVILLE
Practice Address - State:UT
Practice Address - Zip Code:84017-8401
Practice Address - Country:US
Practice Address - Phone:801-358-3365
Practice Address - Fax:208-567-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy